Air cystoscopy is superior to water cystoscopy for the diagnosis of active hematuria.

PURPOSE: We evaluated the clinical use of air cystoscopy, including its possible advantages and disadvantages over water cystoscopy. MATERIALS AND METHODS: Two independent observers prospectively studied consecutive patients who underwent water cystoscopy first and then air cystoscopy at our center from May to September 2012. The indication for rigid cystoscopy in the operating room was noted independently by either observer. Findings after rigid cystoscopy were correlated with the results of flexible water and air cystoscopy using the Pearson correlation and Student t-test. RESULTS: Included in the study were 57 patients with active hematuria, of whom 36 had bladder cancer, and 257 with a history of bladder tumor. The cause of bleeding was clearly identified on water cystoscopy in 22 patients (38%), including tumors in 17 and prostate bleeding in 5, and by air cystoscopy in 49 (86%), including tumors in 32 and prostate bleeding in 17. For diagnosing bladder tumors air cystoscopy had higher sensitivity than water cystoscopy (88% vs 47%, p=0.003) and similar specificity (97% vs 100%, p=0.93). In the 295 patients without hematuria there was no difference in the indication compared to that identified on rigid cystoscopy (43 vs 43, p=1.0). Water cystoscopy revealed more small papillary tumors than air cystoscopy but the number was not significantly different (76 vs 67, p=0.26). All such implants identified on water cystoscopy alone were less than 2 mm. No complication specifically related to air cystoscopy was noted. CONCLUSIONS: We found no statistical difference between water and air cystoscopy in patients without hematuria. Air cystoscopy had higher sensitivity and specificity for diagnosing active hematuria while adding almost no specific complications to the procedure.

Quality of life of multiple sclerosis patients: translation and validation of the Spanish version of Qualiveen.

PURPOSE: Up until now there were no specific questionnaire translated into Spanish for evaluating urinary disorder specific health-related quality of life (HRQoL) associated with multiple sclerosis (MS). Qualiveen is recommended by the European Association of Urology guidelines as a tool for evaluating neurogenic lower urinary tract dysfunction. The objective was to translate the Qualiveen into Spanish, adapt it cross-culturally and validate it against the currently available tools. MATERIALS AND METHODS: A bidirectional translation of Qualiveen was undertaken by professional translators. One hundred two Spanish MS patients were sent the Qualiveen and the ICIQ-SF questionnaires twice within a month. The questionnaires were sent and received by mail and reviewed when the patients came for the scheduled visit. RESULTS: Eighty-one patients participated. The validation study showed that the Spanish version of Qualiveen has good internal consistency with Cronbach's coefficient superior to 0.80 for all the questionnaire's subdomains and also for the entire Qualiveen demonstrating high discriminative power. Also the test-retest analysis proved internal stability of the Qualiveen (kappa coefficient between 0.81 and 0.89). Finally, all the Qualiveen scores correlated with the ICIQ-SF final score. CONCLUSIONS: The Spanish version of Qualiveen functions similarly to the English language version retaining its discriminating power. It has shown it could be a valid instrument for discriminating between patients in a cross-sectional survey, as well as for measuring within subject changes over time thus evaluating the extent to which MS patients' HRQoL is impaired by urinary-related problems.

Measurement of waist circumference for retrospective studies - prospective validation of use of CT images to assess abdominal circumference.

INTRODUCTION: To validate the use of supine position and CT images for assessing abdominal circumference (AC). METHOD: A prospective study in consecutive patients undergoing scheduled abdominal CT at our center between 17 and 25 September 2012. AC was measured four times: Measurements 1 and 2 were sequentially done by the same trained nurse before abdominal CT just above the iliac crest, while measurements 3 and 4 were done on the last abdominal CT slice not showing the iliac bone. Student's t tests and Q-Q and Bland-Altman plots were used for statistical analysis. RESULTS: A total of 102 patients were recruited. Mean age, 60 (35-78) years. Mean BMI, 25 (18-39) kg/m(2). Mean AC, 93.2 (73-135) cm. No significant differences were found between the four ACs measured (Student's t test, P=0.83). Q-Q and Bland-Altman plots showed good overlapping for the low and central values (73-110 cm) with a greater scatter for extremely high values. For the ellipse estimation, R(2) was 0.987 with a mean error of 0.4 cm and a stretch dispersion between 1.1 and -0.3 cm. CONCLUSION: Supine (either measured or estimated on CT images by free hand elliptical ROI or ellipse formula) and standing measurements appear to be equivalent for abdominal circumferences <110 cm.

The evolution of CT diagnosed papillae tip microcalcifications: can we predict the development of stones?

OBJECTIVES: To determine the incidence of computed tomography (CT) identifiable Randall plaques in a CT explored population; to determine the clinical relevance of this radiological finding by a 7-year follow-up; to determine a cut point to identify a population with high risk of developing calcium stone disease (SD). MATERIALS AND METHODS: Retrospective study of all patients explored by abdominal CT in our center between January and March 2005. INCLUSION CRITERIA: age 30-60 years and no SD. Papillae attenuation was measured on nonenhanced CT in Hounsfield units (HU) and the mean of all papillae was calculated. Patients were re-evaluated after 7 years to identify calcium stone formers. Anamnesis and already available CT, ultrasound, kidney, ureter, and bladder radiograph (KUB) or intravenous urography (IVU) images performed as part of their follow-up were used. In patients with no follow-up, ultrasound and KUB were to be performed. Pearson correlation, Student t-test, and the receiver operator curve were used for statistical analysis. RESULTS: A total of 362 patients fulfilled the inclusion criteria and were analyzed; 12 developed calcium SD after 7 years. A significant difference was encountered between the papillae attenuation of stone formers (SF) versus non-SF (47.2HU vs. 35.5HU, p=0.001). There was good correlation between papillae attenuation and the possibility of developing SD (R=0.87). An optimal cut point of 43HU with a sensitivity of 81% and specificity of 97%, area under the curve 0.91, separated SF and non-SF. CONCLUSION: Patients with high papillae density have a higher risk of developing SD. A cut point of 43HU could accurately be used to identify a high-risk population.

Abdominal computed tomography--a new tool for predicting recurrent stone disease.

PURPOSE: To evaluate whether CT-identified Randall plaques can be used to foresee the recurrence of stone disease (SD); to define a cut point that could identify a high-risk population. MATERIALS AND METHODS: A retrospective study of patients attended for SD from January 2004 to December 2009 was conducted. Study population was patients with a first episode of calcium SD that was diagnosed by abdominal CT. Papillae tip attenuation was measured in Hounsfield units (HU) on unenhanced abdominal CT images. Patients with recurrent SD were identified; t test, Pearson correlation, and receiver operating characteristic (ROC) curve analysis were used. RESULTS: A total of 543 patients were evaluated; 187 fulfilled the criteria and were included, and 49 (26.2%) had recurrent SD. Mean follow-up: 5 years (3-7 years). Papillae tip attenuation was significantly higher in the recurrent group (46.2 HU vs 40.1 HU, P=0.01) and correlated well with the possibility of developing SD (R=0.83). Attenuation >43 HU showed a ROC curve area under the curve=0.87 with sensitivity=77% and specificity=84% separating patients with a RR=8.7 of development of recurrent SD. The number of papillae >43 HU correlated with recurrent SD (RR=11.2 for ≥3 papillae vs <3 papillae with density >43 HU). CONCLUSIONS: The presence of the Randall plaques can be used as a marker for predicting SD recurrence. A cut point of 43 HU could be used to identify a high-risk population.

Validation of Randall's plaque theory using unenhanced abdominal computed tomography.

OBJECTIVE: To determine whether nephrolithiasis is associated with radiographic changes in renal papillae. MATERIALS AND METHODS: We performed a prospective study comparing papillae attenuation in a stone-forming group (SFG) and a healthy stone-free control group (CG). The SFG inclusion criteria were active stone disease diagnosed by abdominal computed tomography and stone analysis showing calcium composition. For the CG, we included living kidney donors without stone disease. Papillae tip attenuation was measured using nonenhanced computed tomography scans in Hounsfield units (HUs) for an area with a mean size of 0.1 cm(2). The mean density of the 3 caliceal groups was calculated for each kidney. Student's t test was used for statistical analysis, and the receiver operating characteristic curve was used to determine a threshold separating the CG and SFG. RESULTS: A total of 134 SFG and 134 CG patients met the inclusion criteria. The SFG and CG had similar demographic characteristics. Unilateral lithiasis was encountered in 92 patients (68.6%). The mean HU density of the papillae of the affected side in the SFG was significantly greater than in the CG (43.9 HU vs 33.9 HU, P = .001). No significant difference was seen between the affected and unaffected side in the SFG (43.9 HU vs 42.9 HU, P = .56). The receiver operating characteristic analysis showed an area under the curve of 0.91, with an optimal threshold at 40 HU and a specificity of 92% and a sensitivity of 91%. CONCLUSION: The density of the renal papilla significantly increased in the SFG in both the affected and the nonaffected kidneys compared with the CG. These findings suggest the presence of calcium deposits in the papillae, validating Randall's theory.